Condensing osteitis of the clavicle in children

Table 3 Differential diagnosis

Disease	Clinical and/or radiological features
Osteoarthritis	Narrowed joint space with marginal osteophytes, sclerosis restricted to the sub-chondral bone on both sides of the joint
Infection	Bone destruction, synovial abnormality, joint space narrowing, and periosteal reaction
Chronic, sclerosing osteomyelitis	Dense sclerosis similar to condensing osteitis of the clavicle, but periosteal reaction and/or foci of bone destruction
Osteoblastic lesion	Different age at onset, shorter duration of symptoms, epiphyseal location is atypical, periosteal reaction ± bony destruction, progression on serial studies
Metastases	As a solitary bone scan abnormalities in the clavicle epiphysis (unusual)
Osteoid osteoma	Classic central lucent nidus
Sternoclavicular hyperostosis	Usually bilateral, ossification of sterno-clavicular ligaments, bone scan abnormalities at sternum superior ribs, spinal ligamentous ossification and sacro-iliac abnormalities, systemic and specific dermatologic manifestations (palmoplantar pustulosis)
Friedreich’s disease	Shorter duration of symptoms, clearer relationship to trauma, bone scan similar, X-rays similar ± subchondral irregularity and focal lucencies, biopsy: Osteonecrosis is typical (but marrow fibrosis or osteonecrosis have been described in several cases of condensing osteitis of the clavicle)
Tietze’s syndrome	Involvement of one or more costal cartilages, the clavicle is not involved on radiographs or scan
Chronic recurrent multifocal osteomyelitis	The lesion is initially lytic and with healing, sclerotic and expansile, involves the middle two thirds sparing the medial end, and is typically at presentation. Inflammatory process can be seen at histological examination
Paget’s disease	Greater area involved, and the bone scan dramatically more abnormal, localizations in other bones, elevated level of alkaline phosphatase occurs in adults